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首页> 外文期刊>The journal of sexual medicine >Commentary: Who is a candidate for testosterone therapy? A synthesis of international expert opinions
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Commentary: Who is a candidate for testosterone therapy? A synthesis of international expert opinions

机译：评论：谁是睾丸激素治疗的候选人？国际专家意见的综合

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Introduction: Despite increasing use of testosterone therapy (TTh) for men with testosterone deficiency (TD), there remains uncertainty determining who is a candidate for treatment. Aim: The aim if this study was to report the opinions of international experts on TTh, as initially presented at the meeting of the World Meeting on Sexual Medicine in Chicago, United States in August 2012. Methods: Expert responses to questions regarding the diagnosis of TD based on their own clinical and research experience. Results: All experts emphasized the primacy of symptoms for the diagnosis of TD. Total testosterone (T) thresholds used to identify TD ranged from 350ng/dL to 400ng/dL (12-14nmol/L); however, experts emphasized the diagnostic limitations of this test. Free T was obtained by all, with some valuing this test more than total T for clinical decision making. Only one expert routinely used a screening questionnaire. None used age-adjusted values. Bioavailable T and the free androgen index were not used. Luteinizing hormone (LH) and sex hormone-binding globulin levels were routinely obtained at evaluation. Additional supportive evidence for TD diagnosis included small testicular volume, high androgen receptor CAG repeats, elevated LH, and presence of diabetes or metabolic syndrome. Two T tests were generally obtained but not always required. Some experts did not require morning testing in men 50 years and older. All monitored prostate-specific antigen and hematocrit after initiation of TTh. All but one expert would consider a trial of TTh to a symptomatic man with total T within the normal range. Recent studies suggesting increased cardiovascular risk with T therapy were not found to be credible. Conclusions: Determining who is a candidate for TTh requires clinical assessment based on symptoms and signs, with confirmatory laboratory evaluation. These expert opinions differed from some published guidelines by the emphasis on symptoms as paramount, recognition of the limitations of total T as a diagnostic test, and the potential utility of a therapeutic trial in symptomatic cases with normal total T concentrations.
机译：简介：尽管对于睾丸激素缺乏症（TD）的男性越来越多地使用睾丸激素疗法（TTh），但仍不确定谁可以治疗。目的：本研究的目的是报告国际上有关TTH的观点，该观点最初于2012年8月在美国芝加哥举行的世界性医学会议上提出。方法：专家对有关TTH诊断的问题的回答TD基于自身的临床和研究经验。结果：所有专家都强调症状对于TD诊断的重要性。用于识别TD的总睾丸激素（T）阈值介于350ng / dL至400ng / dL（12-14nmol / L）之间;但是，专家强调了该测试的诊断局限性。所有人都获得了游离T，有些人认为这项测试对总T的评价高于临床决策的总T。只有一名专家常规使用筛查问卷。没有人使用年龄调整后的值。没有使用生物利用度T和游离雄激素指数。评估时常规获得黄体生成素（LH）和性激素结合球蛋白水平。 TD诊断的其他支持证据包括睾丸体积小，雄激素受体CAG重复数高，LH升高以及存在糖尿病或代谢综合征。通常获得两次T检验，但并非总是必需的。一些专家不要求50岁以上的男性进行早间检查。 TTh启动后，所有受监测的前列腺特异性抗原和血细胞比容。除一名专家外，所有患者都将考虑对总有T在正常范围内的有症状男人进行TTh试验。最近的研究表明，使用T疗法增加心血管疾病的风险并不可信。结论：确定谁是TTH候选者需要根据症状和体征进行临床评估，并进行实验室验证性评估。这些专家的意见与某些已发布的指南有所不同，其重点在于症状至为重要，认识到总T的局限性作为诊断测试，以及在总T浓度正常的有症状病例中进行治疗性试验的潜在效用。

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